Healthcare Provider Details

I. General information

NPI: 1508864885
Provider Name (Legal Business Name): LOREN D HARTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 HOLLY ST
HOLLY HILL SC
29059-2762
US

IV. Provider business mailing address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-7174
  • Fax:
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23851
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: